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156/Tricuspid valve injury following trans-venous lead extraction

European Journal of Arrhythmia & Electrophysiology. 2019;5(Suppl. 1):abstr156

Introduction: Trans-venous lead extraction (TLE) carries a risk of tricuspid valve injury with the potential for acute tricuspid regurgitation (TR). Currently there is little data on the incidence of valve trauma and clinical outcomes following TLE. We sought to establish the incidence of worsening TR post extraction in a high volume cardiac tertiary centre.

Methods: Procedural technique, success and outcomes were assessed in addition to pre and post-procedural echocardiography. Acute worsening of TR was defined as a ≥1 grade increase in TR severity and post-extraction TR severity that was ≥ moderate.

Results: 147 leads were extracted from 83 consecutive patients from January 2017–May 2018. There were 40 RV pacing leads, 44 RV defibrillator leads extracted as well as 12-LV leads and 51 atrial leads. Median age of leads extracted were 8.2 years (range 1 month–38 years). Complete procedural success was achieved in 71 (85.5%), clinical success in 79 (95.2%); 33 TLE procedures (40%) were for device infection indications. TLE equipment used included: Tightrail rotating dilator sheaths in 65, Evolution mechanical dilator sheaths in 13, cutting sheaths in 6 and femoral workstation in 8.

Post-extraction echocardiographic data were available in 67 (80.7%);
≥ moderate TR was present post TLE in 16 (23.8%). TR was acutely worsened in 10 (16.4%) post-TLE; acute severe mitral regurgitation occurred in one (1.5%) following trans-septal left ventricular lead extraction, requiring mitral valve replacement. Major complications occurred in five (6.0%), minor complications in four (4.8%). Patients with worsening TR had older leads although not statistically significant.

Conclusions: Significant TR and acute worsening of TR severity are common following TLE. This may be of importance to patients who develop right sided heart failure following TLE. No clear indicators to predict acute TR were present in this cohort. The long-term implications of TLE related TR on patient outcomes remains unknown.

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